Repair of coarctation with resection and extended end-to-end anastomosis

Carl L. Backer, Constantine Mavroudis, Elias A. Zias, Zahid Amin, Thomas J. Weigel

Research output: Contribution to journalArticle

Abstract

Background. Our surgical strategy for infant coarctation changed from subclavian flap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy. Methods. From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20 ± 0.24 years (median, 21 days). In 34 patients (62%), arch reconstruction was performed through a left thoracotomy. Twenty patients (36%) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture. Results. There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on esxtracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8 ± 17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6%. Conclusions. Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta.

Original languageEnglish (US)
Pages (from-to)1365-1371
Number of pages7
JournalAnnals of Thoracic Surgery
Volume66
Issue number4
DOIs
StatePublished - Oct 1 1998
Externally publishedYes

Fingerprint

Aortic Coarctation
Sternotomy
Ventricular Heart Septal Defects
Meconium Aspiration Syndrome
Polypropylenes
Paraplegia
Thoracotomy
Carotid Arteries
Pulmonary Hypertension
Sutures
Survivors
Dilatation
Pneumonia
Hemorrhage
Membranes
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Repair of coarctation with resection and extended end-to-end anastomosis. / Backer, Carl L.; Mavroudis, Constantine; Zias, Elias A.; Amin, Zahid; Weigel, Thomas J.

In: Annals of Thoracic Surgery, Vol. 66, No. 4, 01.10.1998, p. 1365-1371.

Research output: Contribution to journalArticle

Backer, Carl L. ; Mavroudis, Constantine ; Zias, Elias A. ; Amin, Zahid ; Weigel, Thomas J. / Repair of coarctation with resection and extended end-to-end anastomosis. In: Annals of Thoracic Surgery. 1998 ; Vol. 66, No. 4. pp. 1365-1371.
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abstract = "Background. Our surgical strategy for infant coarctation changed from subclavian flap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy. Methods. From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20 ± 0.24 years (median, 21 days). In 34 patients (62{\%}), arch reconstruction was performed through a left thoracotomy. Twenty patients (36{\%}) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture. Results. There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on esxtracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8 ± 17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6{\%}. Conclusions. Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta.",
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